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. 2022 May;20(5):e1170-e1179.
doi: 10.1016/j.cgh.2021.10.030. Epub 2021 Oct 26.

Impact of the COVID-19 Pandemic on Hospitalizations for Alcoholic Hepatitis or Cirrhosis in Alberta, Canada

Abdel Aziz Shaheen  1 , Kristine Kong  2 , Christopher Ma  3 , Chelsea Doktorchik  2 , Carla S Coffin  4 , Mark G Swain  4 , Kelly W Burak  4 , Stephen E Congly  4 , Samuel S Lee  4 , Matthew Sadler  4 , Meredith Borman  4 , Juan G Abraldes  5
Affiliations

Impact of the COVID-19 Pandemic on Hospitalizations for Alcoholic Hepatitis or Cirrhosis in Alberta, Canada

Abdel Aziz Shaheen et al. Clin Gastroenterol Hepatol. 2022 May.

Abstract

Background & aims: Coronavirus disease 2019 (COVID-19) pandemic lockdown and restrictions had significant disruption to patient care. We aimed to evaluate the impact of COVID-19 restrictions on hospitalizations of patients with alcoholic and nonalcoholic cirrhosis as well as alcoholic hepatitis (AH) in Alberta, Canada.

Methods: We used validated International Classification of Diseases (ICD-9 and ICD-10) coding algorithms to identify liver-related hospitalizations for nonalcoholic cirrhosis, alcoholic cirrhosis, and AH in the province of Alberta between March 2018 and September 2020. We used the provincial inpatient discharge and laboratory databases to identify our cohorts. We used elevated alanine aminotransferase or aspartate aminotransferase, elevated international normalized ratio, or bilirubin to identify AH patients. We compared COVID-19 restrictions (April-September 2020) with prior study periods. Joinpoint regression was used to evaluate the temporal trends among the 3 cohorts.

Results: We identified 2916 hospitalizations for nonalcoholic cirrhosis, 2318 hospitalizations for alcoholic cirrhosis, and 1408 AH hospitalizations during our study time. The in-hospital mortality rate was stable in relation to the pandemic for alcoholic cirrhosis and AH. However, nonalcoholic cirrhosis patients had lower in-hospital mortality rate after March 2020 (8.5% vs 11.5%; P = .033). There was a significant increase in average monthly admissions in the AH cohort (22.1/10,000 admissions during the pandemic vs 11.6/10,000 admissions before March 2020; P < .001).

Conclusions: Before and during COVID-19 monthly admission rates were stable for nonalcoholic and alcoholic cirrhosis; however, there was a significant increase in AH admissions. Because alcohol sales surged during the pandemic, future impact on alcoholic liver disease could be detrimental.

Keywords: Alcohol Related Liver Disease; Alcoholic Hepatitis; COVID-19; Cirrhosis; Pandemic.

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Figures

Figure 1
Figure 1
Monthly hospitalizations rate in Alberta between March 2018 and September 2020.
Figure 2
Figure 2
Monthly hospitalizations rates for the 3 study cohorts between March 2018 and September 2020.
Figure 3
Figure 3
Alcoholic hepatitis hospitalizations increased during the COVID-19 pandemic (infection point: March 2020).
See this image and copyright information in PMC

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